Section 18.74.200 - Intramuscular needling-Endorsement(1) Subject to the limitations of this section, a physical therapist may perform intramuscular needling only after being issued an intramuscular needling endorsement by the secretary. The secretary, upon approval by the board, shall issue an endorsement to a physical therapist who has at least one year of postgraduate practice experience that averages at least 36 hours a week and consists of direct patient care and who provides evidence in a manner acceptable to the board of a total of 325 hours of instruction and clinical experience that meet or exceed the following criteria:(a) A total of 100 hours of didactic instruction in the following areas: (i) Anatomy and physiology of the musculoskeletal and neuromuscular systems;(ii) Anatomical basis of pain mechanisms, chronic pain, and referred pain;(iii) Trigger point evaluation and management;(iv) Universal precautions in avoiding contact with a patient's bodily fluids; and(v) Preparedness and response to unexpected events including but not limited to injury to blood vessels, nerves, and organs, and psychological effects or complications.(b) A total of 75 hours of in-person intramuscular needling instruction in the following areas: (i) Intramuscular needling technique;(ii) Intramuscular needling indications and contraindications;(iii) Documentation and informed consent for intramuscular needling;(iv) Management of adverse effects;(v) Practical psychomotor competency; and(vi) Occupational safety and health administration's bloodborne pathogens protocol.(c) A successful clinical review of a minimum of 150 hours of at least 150 individual intramuscular needling treatment sessions by a qualified provider. A physical therapist seeking endorsement must submit an affidavit to the department demonstrating successful completion of this clinical review.(2) A qualified provider must be one of the following: (a) A physician licensed under chapter 18.71 RCW; an osteopathic physician licensed under chapter 18.57 RCW; a licensed naturopath under chapter 18.36A RCW; a licensed acupuncture and Eastern medicine practitioner under chapter 18.06 RCW; or a licensed *advanced registered nurse practitioner under chapter 18.79 RCW;(b) A physical therapist credentialed to perform intramuscular needling in any branch of the United States armed forces;(c) A licensed physical therapist who currently holds an intramuscular needling endorsement; or(d) A licensed physical therapist who meets the requirements of the intramuscular needling endorsement.(3) After receiving 100 hours of didactic instruction and 75 hours of in-person intramuscular needling instruction, a physical therapist seeking endorsement has up to 18 months to complete a minimum of 150 treatment sessions for review.(4) A physical therapist may not delegate intramuscular needling and must remain in constant attendance of the patient for the entirety of the procedure.(5) A physical therapist can apply for endorsement before they have one year of clinical practice experience if they can meet the requirement of 100 hours of didactic instruction and 75 hours of in-person intramuscular needling instruction in subsection (1)(a)(i) and (ii) of this section through their prelicensure coursework and has completed all other requirements set forth in this chapter.(6) If a physical therapist is intending to perform intramuscular needling on a patient who the physical therapist knows is being treated by an acupuncturist or acupuncture and Eastern medicine practitioner for the same diagnosis, the physical therapist shall make reasonable efforts to coordinate patient care with the acupuncturist or acupuncture and Eastern medicine practitioner to prevent conflict or duplication of services.(7) All patients receiving intramuscular needling from a physical therapist must sign an informed consent form that includes:(a) The definition of intramuscular needling;(b) A description of the risks of intramuscular needling;(c) A description of the benefits of intramuscular needling;(d) A description of the potential side effects of intramuscular needling; and(e) A statement clearly differentiating the procedure from the practice of acupuncture.(8) Intramuscular needling may not be administered as a stand-alone treatment within a physical therapy care plan.Added by 2023 c 198,§ 2, eff. 7/23/2023.*Reviser's note: The term "advanced registered nurse practitioner" was changed to "advanced practice registered nurse" by 2024 c 239 s 1, effective June 30, 2027.